2016 CDBG PUBLIC WORKS NATIONAL OBJECTIVE PREAPPROVAL APPLICATION The following checklists are provided as a tool for use in completing the National Objective preapproval process for the 2016 Public Works application cycle. Please submit the required Exhibit E form along with the following information. Return completed information to Nebraska Department of Economic Development, Attn: Rebecca Schademann, Public Works Program Representative, PO Box 94666, Lincoln, NE 68509 no later than Monday, May 9, 2016. You may also email the National Objective Preapproval Application and any required support documentation to: Rebecca.Schademann@nebraska.gov. Name of Community Address Phone E-mail Prepared by Address Phone E-mail Project Summary Number of Individuals Currently Served Number of LMI individuals currently served Percent of LMI benefit Number of individuals to be served at project completion Number of LMI individuals to be served at project completion National objective selected: LMA LMC Census Survey, Attach Completed Exhibit E-1 Random Survey, Attach Completed Exhibit E-2 LMA-US Census Data, Complete checklist below LMC, Attach Completed Exhibit E-3 If LMI is met by most current Census, please provide the following supporting documentation: Census LMI % HUD Census LMI Information (All Counties and Municipalities) Estimates based on the 2006-2010 American Community Survey http://www.neded.org/community/grants/applications/incomelimits cdbg home nahtf
Supporting Documentation: Narrative description with documentation on how activity complies with the appropriate national objective selected HUD Census map Methodology for establishing geographical boundaries of service area (predominant users, corroborating evidence) Document service area is primarily residential (attach map delineating service area, location of activity, dominant land uses and vacant parcels) Document how planned or potential future uses of vacant parcels would impact LMI benefit Documentation can be obtained from: http://www.hud.gov/offices/cpd/systems/census/ne/index.cfm If LMI is met by CENSUS SURVEY, please provide the following: Exhibit E-1 Part I & II completed and attached Yes No Supporting documentation: Census Survey Date conducted Conducted by Copies of 5 completed survey forms Copy of list used to compile families/households in service area Copy of list used to disseminate the survey, indicating families who completed the survey Map indicating service area boundaries and location of families who completed the survey Copy of all publications/ads/letters directed toward citizens to publicize the survey If LMI is between 51% and 54%, additional analysis of the distribution curve of family sizes above and below and family percentages. Certification signed and notarized (if not on letterhead)
If LMI is met by RANDOM SURVEY, please provide the following: Exhibit E-2 Part I & II completed and attached Yes No Supporting documentation: Random Survey Date conducted Conducted by Copies of 5 completed survey forms Copy random table used Copy of list used to compile families in the service area Copy of the list used to determine which families were part of the random sample, the oversample, and indicate which of those families responded, which families had to be replaced, which families from the oversample were used as a replacement and which families they replaced Copy of all publications/ads/letters directed toward citizens to publicize the survey Map of the service area indicating which households responded to the survey If LMI is between 51% and 54%, additional analysis of the distribution curve of family sizes above and below and family percentages. Certification signed and notarized (if not on letterhead)
If LMI is met by Limited Clientele (LMC), please provide the following: Exhibit E-3 Part I & II completed and attached Yes No Identify group generally presumed by HUD to be principally L/M persons for this project. Abused children Elderly persons (age 62+) Battered spouses Homeless persons Severely disabled adults Illiterate adults Persons living with AIDS Migrant Farm Workers Total number of LMC Beneficiaries Number of beneficiaries who are LMI Provide information on family size and income so that it is evident that at least 51% of the clientele are persons whose family income does not exceed the appropriate LMI limit (i.e. day care facility) Income eligibility requirements that limit the activity exclusively to LMC persons If the project consists of removal of architectural barriers, describe project in detail Documentation showing the activity is used by a segment of the population presumed by HUD to be LMC persons (i.e. senior center) Documentation that the facility or service will be used exclusively by LMC persons Documentation describing how the nature and/or the location of the activity establish that it will be used primarily by LMC persons
2016 CDBG PUBLIC WORKS NATIONAL OBJECTIVE PREAPPROVAL APPLICATION Please provide detailed responses to each section below. Proposed Project Summary. Provide a brief quantitative description of the project including linear or square feet, number of persons to be served, frequency and duration of use(s), etc. Proposed Service Area. Describe geographical area of the project to include the entire area to be served by the activity.
2016 CDBG PUBLIC WORKS NATIONAL OBJECTIVE PREAPPROVAL APPLICATION Proposed Project Need. For example, existing conditions, age, structural stability, health and safety, accessibility, etc. Proposed Project Impact. What is the outcome of the project?